Hillary Clinton’s sudden attack on Bernie Sanders’ single-payer health care plan is a dramatic break with Democratic Party doctrine that the problem with single-payer is that it is politically implausible — not that it is a bad idea.

Single-payer, the Canadian-style system in which the government pays for universal health care, takes the health insurance industry out of the picture, saving huge amounts of money. But the health insurance industry has become so rich and powerful that it would never let it happen.

That was certainly Clinton’s position back in the early 1990s, when she was developing her doomed universal coverage proposal for her husband, Bill.

But in the ensuing years, both Clintons have taken millions of dollars in speaking fees from the health care industry. According to public disclosures, Hillary Clinton alone, from 2013 to 2015,  made $2,847,000 from 13 paid speeches to the industry.

Source: Public federal disclosures, Clinton campaign

This means that Clinton brought in almost as much in speech fees from the health care industry as she did from the banking industry. As a matter of perspective, recall that most Americans don’t earn $2.8 million over their lifetimes.

 

Hillary Clinton’s record on single-payer dates back to 1993, when she was tasked to help formulate White House policy. According to the notes of former Clinton confidante Diane Blair, Clinton told her husband during a dinner in February 1993 that “managed competition” — a private health insurance market — was “a crock, single payer necessary; maybe add to Medicare.”

She eventually came to believe that the health care industry was too powerful to allow this reform to happen, and the plan she ended up putting together was not single-payer. Also in 1993, two physician advocates for single-payer lobbied her during a meeting at the White House. They said she told them they made a “convincing case, but is there any force on the face of the earth that could counter the hundreds of millions of the dollars the insurance industry would spend fighting that?”

The next year, in response to a question at a financial conference, then-First Lady Hillary Clinton said that if there was not a health care overhaul “by the year 2000 we will have a single-payer system. I don’t think it’s — I don’t think it’s a close call politically. I think the momentum for a single-payer system will sweep the country.”

Behind the scenes, Clinton continued to show interest in a single-payer plan. David Brock wrote that Alain Enthoven, a Stanford professor who had been brought in to help advise on health care, pushed back on what Brock deemed “her bias toward the single-payer plan.”

In 2008, a young medical student named Lisa Goldman queried Clinton about health care during an event she held in New Haven, Connecticut. Goldman told the Boston Globe that Clinton said she believed the plan to be politically unfeasible at the time, however if a bill establishing it reached her desk, she would sign it into law.

Since then, she has shifted to assailing the policy on its merits.

“We don’t have one size fits all; our country is quite diverse. What works in New York City won’t work in Albuquerque,” she told an assorted audience of 20,000 employees of the electronic health records industry on February 26, 2014; the speech earned her $225,500.

These words were later cited by business lobbyists in New York state earlier this year to argue that if even Hillary Clinton opposed single-payer, why should New York adopt it?

Hillary Clinton’s paid speech circuit came to an end as her campaign revved up. But for her husband, with whom she shares a bank account, it hasn’t. This summer, he was the keynote speaker at America’s Health Insurance Plans (AHIP), the industry group that poured almost $100 million into trying to defeat health care reforms during the fight over the Affordable Care Act.

As part of her newly found opposition to single-payer on the merits, Hillary Clinton’s attacks on Sanders’ health care plan mischaracterize what he is proposing. For example, she has claimed that his plan, which relies on states to administer the single-payer plan, would turn “over your and my health insurance to governors.”

Warren Gunnels, the policy director of Sanders’ campaign, told The Week that actually this is not the case. If a governor chose not to participate, “citizens would receive coverage from the feds.” It’s actually the Clinton-backed status quo under the Affordable Care Act that is allowing governors to pick and choose who to cover.